Step Therapy

Deep dive

Step Therapy: complete reference

Step therapy (also "fail-first therapy") is an insurance utilization-management protocol that requires patients to try and "fail" lower-tier medications before approving higher-tier alternatives. For GLP-1 medications, step therapy typically requires: documented trial of metformin (для diabetes patients), failed lifestyle intervention attempt (для weight management), и often trial of older anti-obesity medications (phentermine, naltrexone-bupropion, или orlistat) before approving GLP-1. Insurance plans use step therapy to control costs by encouraging less-expensive treatments first. Patient experience: prescriber writes для Wegovy, insurance denies, requires documentation of failed step therapy. To navigate: document any prior medication trials с dates + reasons for discontinuation, document lifestyle intervention attempts с structured programs, consider whether stepping through cheaper alternatives makes clinical sense vs appealing с medical necessity letter. Some prescribers can request "step therapy exception" — bypassing step requirements if medical contraindication to lower tiers exists.

In practice

Your insurance denies Wegovy saying "must try phentermine first." Your prescriber documents your previous phentermine trial that caused tachycardia, then resubmits — granted on appeal.

Clinical context

Step therapy is common для GLP-1 weight indications. Document failed prior treatments to facilitate appeals.